Background

The aim of this study was to examine the association between abnormal morphology of the proximal aorta and aortic stenosis (AS) progression rate. The main hypothesis was that morphologic changes of the proximal aorta, such as effacement of the sinotubular junction (STJ), result in increased biomechanical stresses and contribute to calcification and progression of AS.

Methods

Between 2010 and 2012, 426 patients with mild to moderate AS were included in this study. Proximal aortic dimensions were measured at three different levels (i.e., sinus of Valsalva, STJ, and ascending aorta), and sinuses of Valsalva/STJ and ascending aorta/STJ ratios were used to determine degree of aortic deformity. AS progression rate was assessed by annualized increase in mean gradient (median follow-up time, 3.1 years; interquartile range, 2.6–3.9 years). The degree of aortic flow turbulence was examined in 18 matched patients with and without STJ effacement using cardiac magnetic resonance phase-contrast imaging.

Results

Patients' mean age was 71 ± 13 years, and 64% were men. Patients with low ratios had greater AS progression (P < .05). After comprehensive adjustment, sinuses of Valsalva/STJ (P = .025) and ascending aorta/STJ (P = .027) ratios were independently associated with greater AS progression rate. Compared with patients without STJ effacement, those with effacement of the STJ had higher degrees of aortic flow turbulence (24.4% vs 17.2%, P = .038).

Conclusions

Effacement of the STJ is independently associated with greater AS progression, regardless of arterial hemodynamics, aortic valve phenotype, or baseline AS severity. Patients with abnormal proximal aortic geometry had disturbed aortic flow patterns. These findings suggest an interrelation between proximal aorta morphology and stenosis progression.

中文翻译：

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近端主动脉形态与主动脉瓣狭窄进展率的关系

背景

这项研究的目的是检查近端主动脉形态异常与主动脉瓣狭窄（AS）进展率之间的关系。主要假设是近端主动脉的形态变化（例如，耻骨管交界处（STJ）脱落）会导致生物力学应力增加，并导致AS钙化和进展。

方法

在2010年至2012年之间，本研究纳入了426例轻度至中度AS患者。在三个不同的水平（即，Valsalva窦，STJ和升主动脉）测量主动脉近端尺寸，并使用Valsalva / STJ和升主动脉/ STJ比的鼻窦来确定主动脉畸形程度。通过平均梯度的逐年增加来评估AS进展率（中位随访时间为3。1年；四分位间距为2。6-3。9年）。使用心脏磁共振相差成像技术检查了18例有或没有STJ病变的匹配患者的主动脉血流紊乱程度。

结果

患者的平均年龄为71±13岁，男性为64％。低比率患者的AS进展更大（P  <.05）。经过全面调整后，Valsalva / STJ的鼻窦（P  = .025）和升主动脉/ STJ的鼻窦（P  = .027）与更高的AS发生率独立相关。与无STJ消失的患者相比，有STJ消失的患者主动脉血流紊乱程度更高（24.4％比17.2％，P  = .038）。

结论

无论动脉血流动力学，主动脉瓣表型或基线AS严重程度如何，STJ的出现均与AS的发展相关。主动脉近端几何形状异常的患者的主动脉血流模式受到干扰。这些发现表明近端主动脉形态和狭窄进展之间的相互关系。